Crisis resolution
Feature
T he Crisis Services in Hertfordshire Partnership University Foundation Trust ( HPFT ) have recently gone through a transition from Crisis Assessment Treatment Team to become the newly reformed Crisis Resolution Home Treatment Team ( CRHTT ).
The CRHTT ’ s journey began with benchmarking how the trust could improve its services in line with the Core Crisis Resolution Team Fidelity Scale guidelines ( CORE Research Group , n . d .). This follows the NHS Long Term Plan , which focuses on increasing crisis resolution home treatment .
The trust looked at multiple factors and current services , where the gaps lay , what it was doing well and what could be done differently .
The project divided the home treatment pathway into three areas :
• Initial assessment and gatekeeping – to improves access to services .
• Crisis treatment and assessment phase – to formulate care .
• Recovery and resilience support and treatment phase – focusing on treatment intervention .
The key areas identified within this included improving access to crisis support and an introduction of therapies , with the focus being the introduction of occupational therapy and psychology , as well as establishing a consistent approach towards care .
Role of OT in mental health crisis care
The main role of the occupational therapists in the CRHTT is to offer assessments and interventions in the form of one-to-one and groupwork sessions .
The introduction of occupational therapy into the crisis teams supported the new ways of working in several ways . Primarily it has allowed the occupational therapists to be able to support the teams in looking holistically at a person in crisis ; this can be carried out due to the unique dual training that occupational therapists have .
This dual training has allowed occupational therapists in the CRHTTs to assess how both mental and physical health may be impacting on someone ’ s functional ability when in crisis , to allow the clients to carry out day-to-day tasks and become engaged in the activities of daily living that are meaningful to them .
As part of the crisis remodelling in Hertfordshire , occupational therapists were recruited to work within the community-based CRHTTs and in two dedicated units .
We were employed to work in the Glaxo Unit , in the north of the county , with the focus of our role offering intervention and treatment for service users in crisis . The unit opened in December 2020 , with a skeleton staff of two nurses and two occupational therapists , with the aim of expanding over time .
Opening in a pandemic
The decision to open the Glaxo Unit in the height of the pandemic meant that we were incredibly restricted in what we could do from an infection control perspective .
During this time the country was divided into ‘ tiers ’, phrases like ‘ support bubble ’ and ‘ national lockdown ’ were discussed , and the main message to the public was ‘ stay at home ’.
At work , sharing equipment was prohibited , items in client areas had to be wipeable or disposed of after single use , and physical distancing was encouraged . But what was important to remember was that we had a duty of care to assess , treat and support those in mental health crises and we were determined to do this face to face .
There has undoubtably been huge advances in technology with virtual meetings , groups and socialising , but this medium was , and remains , inaccessible to many people from varying economic and social backgrounds .
In 2018 , it was found that 5.3 million adults had never used or did not use the internet regularly ( Office for National Statistics 2019 ).
Recovery through activity
We knew that many of the clients under the crisis team were struggling due to feelings of isolation and loneliness and we wanted to offer a group treatment intervention that would allow service users the opportunity to safely mix with others , while engaging in meaningful activities .
We decided to focus on Recovery through Activity ( Parkinson 2014 ) – a staple book in many mental health occupational therapy teams .
Recovery through Activity is designed to engage adults who are accessing mental health services to enable them to recognise the long-term benefits of occupational participation by exploring a range of activities ( Parkinson 2014 ).
A key element of Recovery through Activity involves active participation and so it was important to ensure that we were able to still engage in activities without breaking infection control guidelines .
It was time to get our creative hats on – a key element to any occupational therapist ’ s brain . Cooking a group meal turned into individual baking spaced two metres apart , playing board games turned into a socially-distanced pub quiz and so on .
32 OTnews June 2022